is study will assess the efficacy of a prenatal and early childhood home visiting intervention, delivered by American Indian (Al) paraprofessionals, to Al teen mothers and their children. The goal of the intervention- Family Spirit-is to reduce risks and promote protective factors that will decrease drug abuse and related health and behavior problems over the lifetime of the mothers and children served. Expectant, reservation- based Al teens face multigenerational challenges, including geographic isolation, history of oppression, poverty, unemployment, limited education, poor access to health and mental health resources, high rates of drug use and fragmented families. These forces are countered by unique protective factors in Native communities including traditions that promote strong extended family networks and emphasis on family as the nexus of strength for individuals. Two decades of research support the efficacy of prenatal and early childhood home visiting programs to prevent health and behavior problems for low income, teen mothers and their children. Home-visiting interventions have not yet been evaluated for Al teens. Although the efficacy of nurse home visiting programs has been proven/the shortage of Al nurses and potential cultural barriers associated with non-Indian home visitors limits the feasibility of this approach for reservation-based teen mothers. Eligible expectant Al teens (N=320), ages 12-19 from four reservation communities will be randomized (1:1) to the Family Spirit Intervention (FS) + Optimized Standard Care vs. Optimized Standard Care (OSC) alone. Parental competence and maternal and child outcomes will be assessed at multiple time points until the child is 36 months old and will include self-reports; interviews; medical, social service and legal record reviews; and observations of the home environment. Study methods and assessments have been piloted since 1998 in previous studies funded by SAMHSA. We propose to assess the efficacy of an American Indian (Al) paraprofessional delivered, home visiting program for reservation-based Al teen mothers and their children. The proposed intervention will: 1) train Navajo and Apache paraprofessionals to implement and assess an evidence-based home-visiting intervention, 2) combine traditional and western understanding of the power of healthy family formation to protect adolescent parents and their children from future risks, and 3) offer new systematic approaches for reducing the burden of drug abuse in Al communities.